MAGI MC

If no Mega Mandatory eligibility exists an individual or case must be evaluated for MAGI MC. MAGI MC includes Children’s Federal Poverty level (FPL) coverage groups including the Optional Targeted Low Income Children’s Program (OTLICP), Parent/Caretaker relative, pregnant women/infant groups, the expanded adult coverage group, Medi-Cal Access Program (MCAP), and County Children’s Health Insurance Program (CCHIP).

MAGI MC evaluates an individual or family’s eligibility based on income, residency and household (tax filing household and relationship).

Per DHCS, Effective July 1, 2022, premiums are no longer imposed or a condition of eligibility for the following programs Optional Targeted Low Income Children’s Program (OTLICP), Medi-Cal Access Program (MCAP), and County Children’s Health Insurance Program (CCHIP).

Children

Children under the MAGI MC rules include biological, step and/or adopted children.

Parent/Caretaker Relative

A parent/caretaker relative is a relative of a dependent child, who is under 19 years of age, by blood, adoption, or marriage with whom the child is living. Caretaker relatives can be, among others, parents, grandparents, great-grandparents, stepparents, siblings, step-siblings, uncles and aunts, cousins, or spouses or registered domestic partners of one of these relatives.

Pregnant Woman/Infant Groups

Pregnant women and infants are generally evaluated with higher federal poverty limits.

Expanded MC (New Adult Group)

Following the implementation of the Affordable Care Act in 2014, childless adults who are not aged, blind or disabled became eligible to receive MC benefits. Adults age 19-64 are potentially eligible for MAGI MC if they meet all other eligibility requirements.

Disabled or blind individuals in the MAGI New Adult group with incomes at or below 128 and without Medicare benefit are considered “not newly eligible” and assigned under aid code L6 (full scope) or L7 (restricted scope). Disabled or blind individuals with income above 128 percent of the FPL, up to or below 138 percent of the FPL, are considered “newly eligible” and remain on aid code M1 (full scope) or M2 (restricted scope).

Parents and Caretaker Relatives not eligible for the ACA Adult group due to non-financial eligibility criteria such as 65 years of age or older or enrollments in Medicare Parts A or B can be reviewed for MAGI MC if income is under 114 percent of the FPL (109% FPL, Plus 5% MAGI disregard).

Reminder: The determination of Non-MAGI Medi-Cal eligibility for a disabled individual received Medicare must be completed.

MAGI Optional Targeted Low Income Child

Optional Targeted Low Income Children Program (OTLICP) children with family income between 160% and 266% will be eligible for full scope Medi-Cal benefits.

MCAP Pregnant Women and Linked Infant and Child

The Medi-Cal Access Program (MCAP) is a health coverage program for pregnant women and infants-

CCHIP

The County Children’s Health Insurance Program (CCHIP) is available in San Mateo, San Francisco and Santa Clara county. CCHIP has higher income limits than MAGI MC and OTLIC. CCHIP is available to citizens, nationals and legal permanent resident children under the age 19.

Note: SB75 does not apply to CCHIP.